The Medicaid Program in the Context of the "Big Beautiful Bill" of the Second Trump Administration

On July 4, 2025, Republican President D. Trump signed the much-talked-about bill on the reconciliation procedure (H.R. 1), known as "The Big Beautiful Bill", concerning healthcare, in particular, changes to the Medicaid programs and the Affordable Care Act (ACA). What is the H.R. 1 bill? This is a major law that changes the rules for government healthcare programs in the United States, the purpose of which is to reduce federal budget expenditures and change the system of assistance to low-income Americans, who are mainly dealt with by the Medicaid program, which helps pay for medical services for low-income Americans. These are, as a rule, children from such families, elderly Americans, and people with disabilities. As a government health insurance program for the poor, Medicaid is one of the cornerstones of the health care system in the United States, targeting health care to low-income and vulnerable groups. The Medicaid program serves more than one in five U.S. residents and covers almost a fifth of health care costs (and half of long-term care costs). It makes up a significant share of state budgets and is a significant part of the entire health care system [1]. What are the main changes that D. Trump's new initiative makes to the Medicaid health care program? How will they affect the health care system in the United States? How will D. Trump's adopted "magnificent bill" affect through funding cuts the Medicaid program on access to services for the implementation of reproductive rights of the American population, and what to expect for states that previously adopted the expansion of Medicaid, as well as those that refused it? The reaction in society to the appearance of the "big, beautiful bill" of the Republican administration of D. Trump is far from unambiguous and requires reflection.

Big Beautiful Bill, Medicaid, Medicare, Affordable Care Act (ACA), Congressional Budget Office (CBO), Federal Medical Assistance Percentage (FMAP), Children's Health Insurance Program (CHIP)